NPIMap

Organization Active NPI

Johnsonburg Dental Center

  • Federally Qualified Health Center (FQHC)
  • Johnsonburg, PA
National Provider Identifier
1164514683
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JOHNSONBURG DENTAL CENTER
Practice address
81 Clarion Rd
Johnsonburg, PA 15845-1656
Phone
(814) 965-5444
Fax
(814) 965-2238
NPI assigned
Sep 29, 2006
Organization subpart
Yes
Parent organization
KEYSTONE RURAL HEALTH CONSORTIA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristie M Bennardi
Title
Ceo
Phone
(814) 486-1115

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

81 Clarion Rd
Johnsonburg, PA 15845-1656

Mailing address

81 Clarion Rd
Johnsonburg, PA 15845-1656
Phone (814) 965-5444

Other names 1

  • Keystone Rural Health Consortia, Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
Keystone Rural HLTH Con6 organizations share this tax ID, including this one
Part of
Keystone Rural HLTH Con

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1164514683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 CLARION RD",
            "city": "JOHNSONBURG",
            "state": "PA",
            "postal_code": "158451656",
            "telephone_number": "814-965-5444",
            "fax_number": "814-965-2238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 CLARION RD",
            "city": "JOHNSONBURG",
            "state": "PA",
            "postal_code": "158451656",
            "telephone_number": "814-965-5444",
            "fax_number": "814-965-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSONBURG DENTAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEYSTONE RURAL HEALTH CONSORTIA INC",
        "enumeration_date": "2006-09-29",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A",
        "authorized_official_last_name": "BENNARDI",
        "authorized_official_first_name": "KRISTIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-486-1115"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keystone Rural Health Consortia, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Johnsonburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.